Traditional Plan PPO 1 in-network Plan pays 80% of allowable charges after you meet your deductible. The benefit is limited to $800 per insured per benefit period. See Outpatient Therapy Services OUTPATIENT PHYSICAL THERAPY 1. There is a $350,000 lifetime maximum per insured in-network and out-of-network combined.

Traditional Plan PPO 1 in-network Plan pays 80% of allowable charges after you meet your deductible. The benefit is limited to $15,000 per insured per benefit period. Plan pays 85% of allowable charges after you meet your deductible. There is a $150,000 lifetime benefit limit. INPATIENT PHYSICAL THERAPY 1. There is a $350,000 lifetime maximum per insured in-network and out-of-network combined.

Traditional Plan Plan pays 80% of allowable charges after you meet your deductible. The benefit is limited to $2000 per lifetime. TEMPOROMANDIBULAR JOINT SYNDROME (TMJ)

Traditional Plan PPO 1 in-network PPO 1 out-of-network Plan pays 80% of allowable charges after you meet your deductible. The benefit is limited to $350,000 lifetime maximum per insured. 2 Plan pays 85% of allowable charges after you meet your deductible. Plan pays 70% of allowable charges after you meet your deductible. TRANSPLANT SERVICES 1. There is a $350,000 lifetime maximum per insured in-network and out-of-network combined. 2. There is an additional $5,000 living expenses benefit.